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Allograft contamination during suture preparation for anterior cruciate ligament reconstruction: an ex vivo study

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  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Effects of suture preparation on graft contamination remain unknown in anterior cruciate ligament reconstruction (ACLR). This study aimed to evaluate the incidence of allograft contamination at different time points of graft preparation and investigate differences in contamination between different sites of the allografts.

Methods

Fourteen hamstring tendon (HT), 9 quadriceps tendon (QT), and 9 bone–patellar tendon–bone (BTB) allografts were harvested, sterilised, and stored following routine procedures. Graft suture preparation was performed with baseball stitching for soft tissue and bone drilling for bone plug. The time was recorded simultaneously. The graft was kept moist in a standard operating room environment for 30 min after the initiation of preparation. The specimens were obtained from the middle and both ends of each graft for culture at three different time points: pre-suturing, post-suturing, and 30 min after the initiation of preparation. A total of 192 specimens were transferred to the microbiology laboratory for culture, identification, and semi-quantitative assessment. Culture results were classified as negative, poor, and abundant based on the extent of growth. Contamination level was recorded as low or high corresponding to culture results of poor or abundant.

Results

The duration of suture preparation was 348, 301, and 246 s for HT, QT, and BTB (P = 0.090). The specimens had a positive culture rate of 41/192 (21.4%), of which 21 were from the ends and 20 from the middle. More positive samples with abundant bacterial growth were detected from the ends than from the middles post-suturing (7/8 vs. 1/7, P = 0.010) and at 30 min (6/11 vs. 0/11, P = 0.012). The total graft contamination rate was significantly higher at 30 min (19/32, 59.4%) than pre-suturing (4/32, 15.6%) and post-suturing (9/32, 28.1%) (P < 0.001). The contamination rate with abundant bacterial growth was higher post-suturing (7/32, 21.9%) than pre-suturing (0%). No statistically significant differences were found among the three types of allografts.

Conclusion

The contamination rate increases significantly at 30 min compared with pre-suturing and post-suturing. Suture preparation may have introduced the high-level contamination, to which the ends of the graft were more prone than the middle. Therefore, routine prophylactic decontamination after suture preparation should be considered, especially for the ends of the grafts.

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Abbreviations

ACLR:

Anterior cruciate ligament reconstruction

HT:

Hamstring tendon

QT:

Quadriceps tendon

BTB:

Bone–patellar tendon–bone

SM :

Sample from the middle

SE :

Sample from each end

ICC:

Intra-class correlation coefficients

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Funding

National Key Research and Development Program of China [2018YFC1106200, 2018YFC1106202], and Shanghai Pujiang Program [Grant No.2020PJD041], and Basic Research Program of Shanghai Sixth People’s Hospital (Grants No. ynms202105).

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Authors and Affiliations

Authors

Contributions

CW, SZ and JZ contributed to conceptualisation. CW, XZ, YQ and SZ contributed to data curation and experiment manipulation. CW, JC and WS contributed to formal analysis and writing. CW, ZY and JJ contributed to measurement. CX and JX contributed to editing and revising. SZ, GX and JZ were responsible for the project administration and supervision.

Corresponding authors

Correspondence to Guoming Xie, Jinzhong Zhao or Song Zhao.

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Conflict of interest

None declared.

Ethics approval

All specimens were obtained from a tissue bank aiming for medical study. Given that this study was carried out as a laboratory study without patient involvement, no ethical approval was required.

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Wu, C., Zhang, X., Qiao, Y. et al. Allograft contamination during suture preparation for anterior cruciate ligament reconstruction: an ex vivo study. Knee Surg Sports Traumatol Arthrosc 30, 2400–2407 (2022). https://doi.org/10.1007/s00167-022-06903-w

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  • DOI: https://doi.org/10.1007/s00167-022-06903-w

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